Biomedical subjects

M K Shear

Publications and source records attributed to M K Shear.

112 records · Page 7Linked to original sources

PubMedDate not supplied

Panic-agoraphobic spectrum: reliability and validity of assessment instruments.

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.

Agoraphobia↗

PubMedDate not supplied

Reliability and validity of the Panic Disorder Severity Scale: replication and extension.

UNLABELLED: The Panic Disorder Severity Scale (PDSS) is a recently developed seven-item instrument to rate overall severity of Panic Disorder. The scale has previously shown good psychometric properties in a sample of Panic Disorder patients with no more than mild agoraphobia. The purpose of this paper is to confirm reliability and validity, to provide an estimate of a cut-score discriminating the presence or absence of current DSM-IV Panic Disorder, and to determine the factor structure of the instrument. PROCEDURES: 104 psychiatric outpatients, including 54 with current Panic Disorder, underwent structured diagnostic assessment and the PDSS interview. The PDSS was repeated within 3-17 days. RESULTS: we confirmed reliability and validity of the instrument and found a one-factor solution fit the data. A cut-off score of eight identifies patients with current panic with a sensitivity of 83.3%, and a specificity of 64%. CONCLUSION: the PDSS is a simple, reliable instrument for use in Panic Disorder studies. A cut-score of eight may be useful as a tool to screen patients in settings such as primary care, for diagnosis-level symptoms.

Adolescent↗

PubMedDate not supplied

Prevalence of mitral valve prolapse in panic disorder: effect of echocardiographic criteria.

Although several investigators have found a higher incidence of mitral valve prolapse (MVP) in patients with panic disorder (PD) and agoraphobia with panic attacks (AgP), there are now several conflicting reports. Discrepancy in the rate of echocardiographic diagnosis of MVP in PD/AgP may be due to different criteria used in evaluating the echocardiogram. In this study, 15 echocardiograms performed on patients with PD/AgP were evaluated by two separate expert echocardiographers. Each used his own standard criteria for diagnosing MVP. The first reader diagnosed MVP in 9 of 15 patients with PD/AgP while the second did not diagnose MVP in any of the 15 patients. This substantiates the belief that criteria variance strongly influences estimates of the prevalence of MVP among patients with PD/AgP.

Adult↗

PubMedDate not supplied

Digitalis delirium: psychiatric considerations.

Digitalis is a ubiquitous drug in modern clinical medicine and digitoxicity is one of the more common iatrogenic disorders. Psychiatric problems are often overlooked as manifestations of digitalis excess and may range from mild disorientation, lethargy, or restlessness to full blown delirium. In this paper we discuss two patients who presented to a psychiatric inpatient unit and were later found to be digitoxic. Psychiatrists are advised to consider digitalis as a possible cause of mental abnormalities and are reminded that psychiatric signs may be the first indication of a potentially lethal drug toxicity. Psychiatric patients may also be at special risk for the development of digitoxicity because of erratic drug taking, electrolyte imbalance or increased autonomic tone.

Confusion↗